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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator a UJ <br /> APPLICATION FOR LAND USE PERMITS N. <br /> o �z_ <br /> OWNER Gr TELEPHONE <br /> p <br /> MAILING ADDRESS G�� �3� �\ I � ;� -t �\ <br /> PROPERTY ADDRESS <br /> I Ne,tJ tO r a, 97Q <br /> LEGAL DESCRIPTION / Ib IXT igN Rj'7 11 b6� tff'41 O tl. <br /> TYPE OF PERMIT(S): SINGLE- MILY DWELLING 0 ADDITION 0 DECK 0 GARAGE/ACCESSORY STRUCTURE 0 4. <br /> BUNKHOUSE 0 59.692(1V)GAZEBO 0 STAIRS 0 FILLING/GRADING 0 CAMPING UNIT EI I <br /> COMMERCIAL BUILDING ❑ COMMERCIAL ADDITI[O�N ❑ `COMMERCIAL ACCESSORY STRUCTURE ❑ S' <br /> STRUCTURE/ADDITION USE: DeC �C F'-Q i Z�t'C Ifs I'C f xt C �'it-c14-# 90 o C� <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> in —h <br /> BUILDING CONTRACTOR: � + C.7t <br /> A <br /> � <br /> PLOT PLAN MUST BE PROVIDED ON AN 8 yz X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS Q o_ <br /> WILL BE RETURNED. Yy <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) c <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. C O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB) AND ALL NEW t�•f w `'' <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, E <br /> AND INDICATE NORTH (N). N z <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S) TO ALL LOT LINES, (B) BUILDINGS) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S) TO THE ORDINARY HIGH WATER MARK <br /> (OHWM) OF LAKE, STREAM OR RIVER AND WETLAND AREAS, AND (D) LOT DIMENSIONS. p r� <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST) AND DRAINFIELD (DF), AND ALL DISTANCES 5. .�. <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. n <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE (� o <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. 3 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN <br /> NEEDED. <br /> J <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> r- <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. n Z t� <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. p \ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. F <br /> 7. " ";0 9 nr) > <br /> 3 '33 3 ^ -. <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my 9 F).°� F <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all �O <br /> ' v m v rn <br /> information contained in this application(including any accompanying schedule)and I further declare that I recognize that this Y a <br /> information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit. I 3 <br /> further accept all liability that may be a result of the County of Burnett relying on this information I am providing in this <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to ave <br /> access to the above-described premises at any reasonable time for th purpose of inspection. o JppRo o <br /> y � � � � � <br /> OWNER'S SIGNATURE <br /> n aomn <br /> (date) o 0 Y <br /> c �a <br /> ZONING ADMINISTRATOR J(in afq <br /> � y <br /> TOWNSHIP PERMITS MAY BE REQUIRED C' °° <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE <br /> �e del + J l �l / l(ICP� �;II / Cr Or.{ !✓ I �-/-� � 0000S <br /> � � i <br />